LIVER-TRANSPLANTATION WITH CAVOPORTAL HEMITRANSPOSITION IN THE PRESENCE OF DIFFUSE PORTAL-VEIN THROMBOSIS

Background. Orthotopic liver transplantation is possible even in the p resence of recipient portal vein thrombosis, provided that hepatopetal portal flow to the graft can be restored. On rare occasions this is n ot possible due to diffuse thrombosis of the portal venous system. In these cases, successful liver transplantation has been considered impo ssible. Portocaval transposition was introduced in the pretransplantat ion era to study the effect of systemic venous flow on the liver and h as been used in three patients for the treatment of glycogen storage d isease. We used portocaval hemitransposition (portal perfusion with in flow from the inferior vena cava) in liver transplantation when portal inflow to the graft was not feasible. We are reporting the collective experience of nine patients from four liver transplant centers. Metho ds. Cavoportal hemitransposition was used in nine patients. In seven o f these cases, the technique was used during the original transplant ( primary group). In two cases, it was used after the portal inflow to t he first transplant had clotted (secondary group). Results. Five of-se ven patients in the primary group are alive after intervals of 6-11 mo nths. The two patients in the rescue group died. Ttl the successful ca ses, liver function and histology were indistinguishable from those of conventional liver transplantation. Ascites disappeared within 3-4 mo nths and the patients were able to return to their normal activities. Postoperative variceal bleeding necessitated splenectomy and gastric d evascularization in one case and splenic artery embolization in anothe r case. Bleeding was controlled in both these cases. Splenectomy and g astric devascularization were performed prophylactically in one patien t with a history of variceal bleeding in order to prevent this complic ation after transplantation. Conclusion. Portocaval hemitransposition maybe useful in liver transplantation when hepatopetal flow to the liv er graft cannot be established by other techniques. Rescue after failu re of conventional technique was not possible in two patients.